Linking Clients to Care: A New Tool

It's a common enough story: someone is diagnosed with HIV. That person is told she needs to visit the doctor as soon as possible. Maybe that person calls for an appointment, and maybe she doesn't - but that person doesn't make it to the doctor that week. Or that month. It could be a child care problem, or a transportation problem, or an appointment availability problem.

But in some cases, it's just that people who were just diagnosed with HIV don't know that there is a system of care available to them -- even if they can't pay for services. In 2010, 18% of newly-diagnosed Philadelphians with HIV weren't linked to care within 90 days. We don't know each person's reasons for not getting medical care right away, but lack of knowledge of the care system is an obvious barrier for newly-diagnosed clients. In fact, through our local needs assessments, we've repeatedly found that many people living with HIV/AIDS report not accessing medical care because they couldn't afford it. We're lucky enough to have a comprehensive system of services available through Ryan White, but newly-diagnosed clients won't know about it if no one tells them it's there.



Here's a preview. Download a copy here.

At the same time, we know that it's not always easy for HIV testers to give consistent messaging while getting important information from their clients.  Enter, our new linkage to care tool. We hope that this tool will relieve some of the burden on HIV testers, increase access to care and other services for newly-diagnosed people with HIV, and improve linkage to care performance for our local provider sites.



We developed this tool after an extensive review of treatment readiness assessments in use across the country, and reduced the questions to the most relevant ones for helping clients with their initial linkage to care.  It was developed in partnership with the Points of Integration Workgroup, which spent a great deal of time honing both the language and the questions.  The tool was then presented to both the Philadelphia EMA Ryan White Part A Planning Council and the Philadelphia HIV Prevention Planning Group for additional feedback and adjustments.

We would like to note that we developed this tool as an aid for providers, and we designed it to help individual HIV testers improve access to services for their clients (and, by extension, to improve their own performance). This tool was not designed for data collection. Testers might decide to make copies and use a separate form for each client, in order to provide an “at a glance” summary of what is most needed to make that first linkage.  They might use pieces of this tool as a supplement to their own routines.  They might keep a copy with them to use as a discussion guide.  How they use the tool is up to them, but we do hope that it proves useful in their day-to-day work.

Of course, like all of our documents, this is free to distribute and reproduce.  We made it in black and white to be copier-friendly. We also included fainter lines in the notes section, allowing the neater testers among us to write along the lines and the more out-of-the-box testers to write willy-nilly in whatever direction they choose. We wanted this to be as user-friendly as possible. In that spirit, we welcome feedback and suggestions. Feel free to comment here, or use the contact information on the form to get in touch.

Download the linkage to care tool here - and share widely!
 

Quick Notes from the Federal AIDS Policy Partnership meeting

The Office of HIV Planning is a member of the Federal AIDS Policy Partnership (FAPP), a coalition of organizations from all over the country that advocate for people living with HIV and the organizations that serve them. You can learn more about FAPP and how to become a member organization here. Individuals living with HIV are also encouraged to join.  The group meets about four times a year, our last meeting was on February 12th. At that meeting we had some informative discussions with Dr. Jonathan Mermin, Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the Centers for Disease Control and Prevention (CDC) and Dr. Laura Cheever, Associate Administrator for HRSA's HIV/AIDS Bureau.  We also discussed updates on implementation of the Affordable Care Act (ACA) and the reauthorization fo the Ryan White Program.

Dr. Mermin's presentation is well worth your time to review (slides here). He shared information on HIV prevention funding, national progress on the National HIV/AIDS Strategy (NHAS), and how the CDC is addressing HIV prevention in terms of the care continuum.  A few things really stuck with me. When talking about new HIV cases, Dr. Mermin mentioned that although incidence has been stable over all, there have been increases in the number of new HIV cases for men who have sex with men and young men who have sex with men, 12% and 22%, respectively. The CDC and it's partners are focusing on High Impact Prevention, as the future of HIV prevention. The keys to High Impact Prevention are aligning HIV prevention resources to the geographical areas and populations most affected by HIV, using cost-effective and evidence-based methods, maximizing the number of people living with HIV/AIDS with a suppressed viral load, and using data monitoring, dissemination and feedback to improve outcomes for organizations and jurisdictions.The CDC is also working closely with HRSA to align as much of the HIV care and prevention activities as possible; including community planning, data reporting, and policies.


A major topic of discussion with Dr. Cheever was the future of the Ryan White program, in the era of health reform (ACA). Much of the conversation was informed by the discussion  at the Ryan White Working Group meeting (the day before). That discussion focused mostly on when and how to advocate for the reauthorization of the law, and what it might include. Consensus from that discussion was it would be best for the community to wait until 2015 to push for reauthorization because so much is still unknown about how Ryan White programs will work in the context of expanded health coverage and other reforms of the ACA. The community of Ryan White providers and consumers need to collect stories of the successes of the program from the local levels: who is served, how their lives are improved, and what benefits and outcomes do we see on an aggregate level. There was also consensus that the next version of the Ryan White law will be transformative, in other words, it will include a lot of changes to how the program works, what services are provided and who is eligible.

Dr. Cheever also recommended that we need to focus our efforts to help people start and stay in HIV care. The local communities need to provide qualitative data (stories) about how and why people get lost and also linked to care. These qualitative data can work with the quantitative data (surveillance, program data) to develop effective plans for our HIV care systems, including Ryan White. Local communities, like the Philadelphia EMA, should focus on those who need the most help accessing and maintaining care and provide the supports they need. Those supports might include housing, mental health treatment, substance abuse treatment, child care, transportation or social support. The Ryan White program has the ability to meet these needs, but we have to direct resources to where they are most needed. We need to adapt the Ryan White system to work with the larger health care systems, not apart from them.

If I come away from these two meetings with any theme, it's "adapt or perish". We all need to become knowledgeable about the ACA and other changes in the science and policy world of HIV/AIDS. We have, as always, to do more with less. So we have to be informed, proactive, and deliberate.

Reducing Risk of HIV Infection for YMSM in Philly

YMSM stands for young men who have sex with men. According to CDC (Center for Disease Control and Prevention) research, MSM account for the largest number of infections when compared to other risk groups and YMSM are particularly vulnerable. The following is a short list of strategies YMSM can use to reduce their risk of contracting HIV and find support in the Philly LGBT community. 

1.)    Get Tested!

You cannot tell by looking at a person whether they have HIV. To reduce your risk of acquiring HIV, you should know your status and that of your partner. The three things you should ask potential sex partners are: “Have you been tested for HIV? When was the last time you had an HIV test? What were the results of your HIV test?” In Philadelphia, many organizations provide HIV testing for free and accept walk-ins. They are anonymous and no appointment is necessary!

Here are a few organizations:

* The Mazzoni Center: Philly’s LGBT health and wellness center. They offer free HIV testing, as well as testing for other STI's. All testing is anonymous and confidential and takes place at their Washington West (1201 Locust St.) location. Hours: Monday-Friday, 9:00a.m.-9:00p.m. Phone: 215-563-0658

* ActionAIDS: ActionAIDS offers free and confidential HIV testing. Their 20-minute rapid test needs no appointment. Walk-in hours for the 1026 Arch St. location are Monday: 11:00a.m.-1:00p.m., Tuesday 10:00a.m.-12:00p.m., Wednesday 1:00p.m.-4:00p.m., Thursday 12:00a.m.-2:00p.m. and Friday by appointment only.

In addition, the CDC has a handy testing locator where you can search for testing sites by zip code!

Find a Testing Site Near You

2.)    Use Condoms!

According to the CDC, a latex condom used consistently and correctly is very effective at preventing HIV infection. The Office of HIV Planning provides free packages with condoms and lube! We are located at 340 N. 12^th Street in Philadelphia, PA. The STD Control Program also provides free condoms at over 100 sites in Philadelphia. The CDC created this handy online condom locator tool:

 Where to Get Free Condoms

3.)    Consider PrEP! 

PrEP (Pre-Exposure Prophylaxis) is an intervention where an HIV-negative person takes HIV meds (Truvada) in order to prevent HIV. Philadelphia is one of the first cities in the United States to implement PrEP programs and trials.  To learn more about PrEP, see the OHP blog:

The Science: PrEP

Philadelphia FIGHT is sponsoring the “I AM Men’s Health Project”, a free program for young gay and biseuxal men who are interested in learning about men’s health and reducing their risk of HIV infection. The weekly group discusses everything from risk reduction to leadership  skills. Each pariticpant will receive a week’s supply of TRUVADA® at each meeting, and remain under the close medical supervision of the Jonathan Lax Center. To find out more, check out the site:

Learn about PrEP

4.)    Be Careful on Social Media Sites! 

Social media sites such as Grindr, Downelink, Jack’d, Plenty of Fish and Ok Cupid can be a fun and easy way to meet with other people in the LGBT community for friendship, dating or casual relationships! However, it is important to be aware that the people on the sites may not be presenting themselves in an honest or accurate way.  If you are planning to meet someone you met through an online social media site or app, consider taking the following steps: limit the amount of personal information you share, tell a trusted person you plan to meet someone and arrange to meet somewhere public.

5.)    Find a support group and attend fun social events!  

Support groups can be a great way to find friends in the LGBT community! The Philadelphia Department of Human Services has created a list of young LGBT support groups:

LGBTQ Youth Resources in Philadelphia

One program that I really like is Q Spot, which is sponsored by the Educational Justice Coalition. The program provides fun social events, mental health services, HIV and STI testing as well as great snacks! The program occurs on the first and third Saturdays of each month from 8:00p.m.-1:00a.m. at 315 S Broad Street, Philadelphia, PA 19107.